WORKERS' COMPENSATION / AUTO PAYER LIST 09/10/2021 …

WORKERS' COMPENSATION / AUTO PAYER LIST 1/5/24

1st Auto & Casualty 21st Century Insurance 22125 Roscoe Corp. AAA Minnesota/Iowa AAA Northern California, Nevada & Utah Insurance Exchange ABC Const. Company ABF Freight System, Inc. (Arkbest) Acadia Insurance Company Accd Accident Fund Insurance Co of America Accuride Corporation Ace Property & Casualty Ins Co ACIG Insurance Company Active Care, Inc. ACTS Retirement - Life Communities Acuity, A Mutual Insurance Company AD-COMP Adelanto Correctional Facility (CA) Administaff Administrative Claim Service, Inc Adminsure Admiral Linen & Uniform Service Advance America Cash Advance Centers Advance Services, Inc. Advanced Auto Parts - All states EXCEPT TX MN Advanced Auto Parts - TX MN Advocare MCO, Inc Allianz Affiliated Foods, Inc. AG Facilities Operations, LLC Agri Beef Co. AIG-Chartis Alarm Contractors (WC Only) Alaska National Insurance Albertsons, Inc. Alcoa Fasteners Systems Alex Lee, Inc. Align Networks (One Call Physical Therapy) Allen Canning Aluminum Precision (Carl Warren) * Allergan W.C. Holding, INC. Alliant Energy Allianz Global Corporate & Specialty (AGCS) - dates of injury on or after 1/1/2018

Payer ID J1585 41556 41556 11983 41556 41556 J3789 J1477 J3729 J1790 J1024 41556 J1578 J3840 J2163 J1240 J1667 J1798 J1241 J1005 J2292 J2144 J1843 J1608 J2162 J2161 J1896 J1452 J1977 41556 41556 19402 J3859 J1577 J2376 J1244 J2166 J1716 J1740

Paper Only J2341 J1619 J2332

TX MN CA IL x x

xx xx xxxx

xx

x

LA NJ NY OR WI NC NM OK TN VA

x

x

x

All States

x x

x x x x x x

x

x x x x x

x x x x x x

x x x x x x x x

x x x x

x xx

x

837P x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

x x x

837I x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

x x x

x x x

WORK COMP

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

AUTO x

835 Rejects Only Rejects Only Rejects Only

x Rejects Only Rejects Only

x Rejects Only

x x x Rejects Only x x x Rejects Only x x x Rejects Only Rejects Only Rejects Only x x x x x x

Rejects Only Rejects Only Rejects Only

x x x Rejects Only x Rejects Only x

Rejects Only x x

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WORKERS' COMPENSATION / AUTO PAYER LIST 1/5/24

Allianz Resolution Management (ARM) - dates of injury on or before 12/31/2012 Allied Claims Administration, Inc. Allied Construction (via EMC Risk Services) (Except CA, NM, NV) Allied Insurance Companies Allied Property and Casualty Ins Co Allmerica Financial Benefits Insurance Company Allstate - Except New Jersey Allstate - NJ Only (Auto Only) Alta Healthcare Alternative Service Concepts (ASC) Alvey Systems (AON Risk) AMCO Ins Co America First American Airlines - DOI after 9/1/2014 ONLY American Alternative Insurance Corporation American Apparel, LLC (DOI after 7/14/16) American Claims Management (ACM) American Coin Merchandising, Inc American Country (Auto Only) American Country (WC Only) American Cyanamid American Family Home Insurance Company American Family Mutual Insurance Company American Furniture Warehouse American Home Craft American Liberty Insurance Company American Millennium American Mining Insurance Group, LLC American Modern Home Insurance Company American Select American Specialty Companies American Specialty Ins. / MIB American Standard Insurance Company of Ohio (AUTO ONLY) American Standard Insurance Company of Wisconsin (AUTO ONLY) Ameriprise (Auto Only) Amerisafe Risk Services Amerisure Insurance Amerisure Mutual Insurance AmFed Companies LLC (Amfed National Insurance) AmGuard Insurance Company - Guard DBA Amica Insurance Company (Auto Only) Amtrust North America ANACO

Payer ID J2326 J1733 J1118 J1550 J1550 J1589 C1037 C1089 41556 J2149 J1025 J1550 J1427 J2000 J4030 J2189 J1236 J1026 C1075 J1249 J1027 J4031 J2134 41556 J1250 41556 J4021 J1524 J4032 J3317 J1028 J1029 C1055 C1055 C1097 J1447 J1206 J1205 J3735 J1453 C1098 J1868 41556

TX MN CA IL xxx xxx xxxx

xxxx

LA NJ NY OR WI NC NM OK TN VA

x

x

x

x

x

x

x

x

x

x

x

x

x

x

All States

x x x

x x

x x x x x

x x x x x x x x x x x x

x x x x x x x

x x x x x

x

837P x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

837I x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

WORK COMP

x x x x x x

x x x x x x x x x x

x x x x x x x x x x x x x

x x x x x

x x

AUTO

x x

x x x

x x x x x x

835 x x x x x x x

Rejects Only Rejects Only Rejects Only

x x Rejects Only x x x Rejects Only x x x x x Rejects Only Rejects Only Rejects Only Rejects Only x x x x x x x x Rejects Only x Rejects Only Rejects Only x x Rejects Only x Rejects Only

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WORKERS' COMPENSATION / AUTO PAYER LIST 1/5/24

ANAIC Cibus Anchor Glass Container Corporation Anheuser Busch Antelope Valley Community Hospital Antelope Valley Ret. Antelope Valley Union High School District APM Terminals Applied Materials Applied Underwriters (Except AZ) Archer Daniels Midland Company Ardagh Group Areas USA, Inc. Argent (Subsidiary of West Bend but this route is Argent only) Argonaut Insurance Company(ARGO) Argus Claims Arizona & 21st Corp. DBA Berkley East Conv. Hospital Arkansas Best Arrowpoint Association Casualty Insurance Company Association County Commissioners of Georgia (ACCG). Athens Athens - ABF Freight Systems, Inc Athens - Alemeda Health Systems Athens - American Apparel, Inc (DOI prior to 7/14/16) Athens - American Brass & Iron Foundry Athens - Angelus Block Athens - Bay Area Housing Authority Risk Management Athens - Central County Fire Department Athens - Children's Hospital Los Angeles Athens - City of Beverly Hills Athens - City of Mountain View Athens - City of San Jose Athens - City of Vernon Athens - County of Solano Athens - Crum Athens - East Bay Municipal Utility District Athens - East Bay Regional Parks District Athens - Fairmont Hotel Athens - FASIS Athens - Golden Gate Bridge Highway & Transportation Athens - Goodwill Industries (San Francisco, San Mateo, Marin Counties) Athens - H&S Venture Athens - Household Industries Self Insured Group

Payer ID 41556 J2136 J1620 J2197 41556 J2185 J3788 J2160 J1775 J1735 J2344 J1944 J1420 19801 J3307 41556 J2142 J1564 J1254 J1869 J1914 J2096 J2097 J2098 J2099 J2100 J2101 J2102 J2103 J2104 J2105 J2106 J2107 J2108 J3728 J2109 J2110 J2111 J2112 J2113 J2114 J2335 J2115

TX MN CA IL x

LA NJ NY OR WI NC NM OK TN VA

All States

x x x x x

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

837P x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

837I x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

WORK COMP

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

AUTO x

835 Rejects Only

x x x Rejects Only x x x Rejects Only x Rejects Only x x x Rejects Only Rejects Only Rejects Only x x Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only x Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only x Rejects Only

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WORKERS' COMPENSATION / AUTO PAYER LIST 1/5/24

Athens - Kings Seafood Company Athens - KPC Healthcare Athens - Long Beach Public Transportation Company Athens - McKesson Corporation Athens - Orora North American Athens - Placentia-Yorba Linda Unified School District Athens - Presbyterian Intercommunity Hospital PIH Athens - San Francisco Unified School District Athens - Sony Corporation of America Athens - Sunsweet Growers, Inc. Athens - Temecula Valley Unified School District Atlantic PPO to U.S. Department of Labor-PA Athens - The Conco Companies - ARCH WC Athens - The Permanente Medical Group, Inc. Athens - Vintage Senior Living Atlantic PPO to Atlantic Imaging Group Atlantic PPO to Hartford Insurance Atlantic PPO to Merchants Mutual Atlantic PPO to NY City Transit Atlantic PPO to NYC Dept. of Sanitation Atlantic PPO TO QBE Insurance Atlantic PPO to Sentry Insurance Atlantic PPO to Travelers Atlantic PPO to US DOL NJ claims Atlantic PPO to US DOL NY claims Aureon HR Solutions (via EMC Risk Services) (Except CA, NM, NV) Austin Mutual Ins Auto Club Group Auto Club Group Insurance Company Auto Club Insurance (ACIA) Auto Club Insurance Association Auto Club Property-Casualty Insurance Company Auto One Insurance (Auto Only) Automobile Dealers Insurance Company Inc Auto-Owners \ Home-Owners Insurance Company Auto-Owners \ Owners Insurance Company Auto-Owners \ Property-Owners Insurance Co Auto-Owners \ Southern-Owners Company Auto-Owners Insurance Company Auto-Owners Life Insurance Company AVIR Inc. Avizent Ayers Trucking

Payer ID J2116 J2117 J2118 J2119 J2120 J2121 J2122 J2124 J2126 J2127 J2128 J2081 J2129 J2131 J2132 J2013 J2035 J2046 J2055 J2056 J2067 J2074 J2079 J2083 J2084 J1118 J1682 11983 11983 11983 11983 11983 C1082 J1861 J1580 J1583 J1699 J1688 J1556 J1596 41556 J1415 J1018

TX MN CA IL

x x x x x

LA NJ NY OR WI NC NM OK TN VA x

All States

x x x x x x x x x x x x x x x x x x x x x x x x x x x

x x x x x x x x x x

837P x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

837I x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

WORK COMP

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

x x x x x x x x x x

AUTO

x x

835 Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only Rejects Only

x x x x x x x Rejects Only Rejects Only x x x x x x Rejects Only Rejects Only x

Page 4 of 52

WORKERS' COMPENSATION / AUTO PAYER LIST 1/5/24

Azz Inc. Baker Tanks, Inc. Balance Staffing Workforce Baldwin County Bank of America Banner Health Baptist Healthcare Systems, Inc (KY ONLY) Bardavon Health Innovations Barker Claim Services Barnes Barrett Business Services Inc (BBSI) BART - San Francisco Bay Area Rapid Transit Bashas Corporate Offices Basic Resources, Inc. Bass Pro Group, LLC Bauman Workers' Compensation Loss Fund Account Bb&T Corporation (Branch Banking & Trust) Beacon Insurance Company Of America Beacon Mutual Beall's Inc / Midwest Employers Bed Bath & Beyond Beeville ISD Belfor USA LTD INC Belk, Inc. Benchmark Insurance Company Bergen Risk Berkley Agribusiness Risk Specialists Berkley Entertainment and Environmental (formerly Berkley Specialty Underwriters) Berkley Mid-Atlantic Group Berkley National Insurance Company Berkley Net Underwriters, LLC Berkley Regional Insurance Company Berkley Risk Administrators Company, LLC Berkley Southeast Insurance Group (BSIG) Berkley Valley Conv Hospital Berkshire Hathaway Direct Insurance Company Berkshire Hathaway Homestate Companies (BHHC) Bernardo H. Co. Club Berwind Corporation Beverly Hills Carmel Big 5 Corp Bighorn Construction BI-Mart

Payer ID J3773 41556 J3844 J4022 J1729 J3811 J2164 J2334 J3818 J1503 J1686 J1770 J3732 41556 J1958 J3305 J1995 J3318 J1234 J1030 J2167 41556 J4023 J2168 J3992 J3997 J2190 TP019 J3863 J2192 J1523 J2194 J1526 J2145 41556 J1975 20044 41556 J1031 41556 J1738 41556 J2349

TX MN CA IL

LA NJ NY OR WI NC NM OK TN VA

All States

x x x x x x

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

837P x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

837I x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

WORK COMP

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

AUTO

835 x

Rejects Only Rejects Only

x x x x Rejects Only Rejects Only x x x x Rejects Only x x x x x x x Rejects Only

x x Rejects Only x x x x x x x Rejects Only Rejects Only x x Rejects Only x Rejects Only x Rejects Only Rejects Only

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